Provider Demographics
NPI:1659133668
Name:SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
Entity Type:Organization
Organization Name:SAFE HARBOR BEHAVIORAL HEALTH OF UPMC HAMOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CLINICAL CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FAUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-451-2225
Mailing Address - Street 1:1330 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1402
Mailing Address - Country:US
Mailing Address - Phone:814-451-2232
Mailing Address - Fax:814-454-7780
Practice Address - Street 1:2556 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4508
Practice Address - Country:US
Practice Address - Phone:814-835-2960
Practice Address - Fax:814-833-0879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA455580OtherSTATE LICENSE